I,m looking for an evednce based Practice to Use Steroids in the treatment of severe Pneumocystis Pneumonie in non-HIV Patients?
Is this true to use it as like as in HIV-Patients (Dose tappering over the 3-weeks)? Is this evednce based?
Remarkable that HIV Book 2022 has recommended a reduced Dosis of Prednisolon AND for a shorter time .
I look forward to your openion ?
Role of adjunctive corticosteroids in non-HIV PCP patients remains controversial. Unlikely in HIV patients where the role of steroids is well stabilised in reducing the mortality, here corticosteroids use has not been shown to improve the outcomes. Unfortunately till date, we don’t have any RCT to determine it. There is a recent propensity score analysis was published in PLOS one (https://doi.org/10.1371/journal.pone.0250611) which described that the Combination of corticosteroids with anti-pneumocystis therapy in non-HIV onco-haematology PJP-patients was not associated with clinical improvement.
The mortality in PJP (non-HIV) is already high compared to HIV patients, moreover majority of these patients has already receiving immunosuppressants, so prolonging steroids >2 weeks is not going to help.
Non HIV patient spectrum is pretty extensive, post chemotherapy, post transplantation and on chronic steroids or other immunosuppressive. Diagnostic methods including serum fungitell may be borderline elevated due to stagnant immune system not reacting against the fungus. Also the quantity of these fungi on cytology is minimal so clinical determination carries a lot of value, I usually check the CD4, CD3 and Absolute lymphocyte count. I would rather treat with steroids and antifungals than not as most of these patients dont fall in a single homogeneous group. Also steroids help in reducing the degree of respiratory failure due to host vs fungal interaction resulting in inflammation and this may not always reveal as a better outcome in studies. It is better to treat them for at-least 3 weeks. PCP (Pneumocystis Pneumonia) in non HIV patients has a high mortality than HIV patients. Post treatment possibly on prophylaxis if the ALC or CD3 or CD4 count is lower.
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